Urinary incontinence can have a variety of causes. Such incontinence results when the urethral sphincter does not close sufficiently to block urine flow through the urethra. A second urinary sphincter malady is urinary retention, which can be caused by spinal cord injury. Urinary retention is the outcome of the urethral sphincter not voluntarily relaxing and opening to allow the urethra to open, causing a state of permanent urinary retention. Particularly in the case of males, there is not much real estate with which to work on the urethra since the prostate surrounds a portion of the urethra, dividing the sphincter muscle into two, whereas for females the sphincter extends along the urethra from the bladder to near where it opens to the outside of the body.
A common treatment for incontinence is simply inserting a catheter into the urethra. Not only is this an uncomfortable nuisance for the patient, it entails the risk is that of urinary tract infections (UTI), which increase in frequency with the number of catheterizations required.
Another treatment which is useful for males only is the use of a so-called artificial urinary sphincter/urethral cuff, in which a working fluid can inflate a cuff that is implanted around the urethra. The working fluid is infused and removed from the cuff pumped by squeezing a pump surgically located in the scrotum. Not only can this device not be used in females, it entails the risk of injury to the scrotum, and patients find it a nuisance to feel for the pump in the scrotum. Moreover, fine tuning the relatively cumbersome cuff to the patient is not possible.
For females, pubovaginal slings made of tissue have been provided in which titanium screws are placed in the pelvic bone on both the sides of the urethra. These screws are attached to sutures that support a strip of tissue that is passed beneath the urethra to support the urethra and the bladder, so that the leakage does not occur during coughing, sneezing, laughing or other physical activities. This procedure does not allow for patient control, and entails a risk of perforation of the urethra or bladder neck due to elevated pressure. A similar approach with similar problems is the use of tension-free vaginal tape in which a “hammock” is wrapped around a portion of the abdominal muscle instead of held in place by screws. There is a risk of perforation of the urethra or bladder neck due to elevated pressure, and the device does not compensate for change due to movement of the abdominal muscles due to weight loss or gain, which could lead to stresses that could cause serious damage. Or, ligaments can be attached to a sagging bladder neck and urethra that have dropped abnormally low in the pelvic area, but as understood herein, this procedure caries many of the risks noted above, and also the risk of tearing/bleeding at the sutures attached to the vaginal wall.